Registration Form

1
Name of Student* This field is required.Name of Sudent
First Name
Last Name
2
E-mail* This field is required.
3
Phone Number:* This field is required.
4
Address:* This field is required.
Street Address
Street Address Line 2
City
County
Postcode
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
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Argentina
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Aruba
Australia
Austria
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The Bahamas
Bahrain
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Belgium
Belize
Benin
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Bhutan
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Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
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Canada
Cape Verde
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Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
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Cote d'Ivoire
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Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
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France
French Polynesia
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The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
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Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
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Hungary
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India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
5
Birth Date:
Day
Month
Year
6
Date of Birth* This field is required.DD/MM/YYYY
7
Birth Date:Please enter your date of birth
8
Student under 18 - Name of Parent/GuardianParent or Guardian who is completing the form
First Name
Last Name
9
Student under 18 continued - What is your relationship to the student?
10
What is the main reason for starting?
Fitness
Self Defence
Sparring
Social
Learn Martial Arts
Other
11
How did you hear about us?
Friend / Family
Facebook
Instagram
Twitter
Leaflet
Poster
Newspaper
Other
12
Medical* This field is required.If you have a diagnosed medical condition or health concerns please consult your doctor before taking part in our classes, to ensure this is suitable for you.
No medical issues which would affect training.
13
Any medical / health conditionsThis information is stored to help assist and tailor any training and instruction.
Huge
Large
Normal
Small
Ok
Ok
14
Previous experiencePlease list any previous martial arts experience
15
Permission to use material/photographs produced by/through Hyung Je Marital Arts.* This field is required.Hyung Je Martial Arts may occasionally permit approved photographers access to the club for marketing and web publications. Your membership grants us the rights to publish any photograph in relation to the club's activities and events unless you decline.
Yes
Please Select
Yes
No
16
Disclaimer of Liability* This field is required.Whilst Hyung Je Martial Arts will take all practicable steps to ensure safety of students and minimise the risk of accident or injury, there is an element of risk associated with any contact sports such as martial arts and self defence It is therefore your responsibility, as a student or as a Parent/Guardian of a student under the age of 18, to acknowledge that the risk of injury cannot be completely eliminated due to the nature of the activities. Parents/Guardians of students under the age of 18 and all students aged 18 and over accept that enrolment into Hyung Je Martial Arts classes and competitions (including externally organised competitions/events) is not a confirmation that the student has the necessary skills or physical abilities to complete all activities. It is your sole responsibility (or the responsibility of Parents/Guardians of students under the age of 18) to judge if you/the student has the ability and aptitude to take part and safely complete any exercise in any Hyung Je Martial Arts classes, grading, competitions or other events. Reckless behaviour will not be tolerated under any circumstances and instructors of Hyung Je Marital Arts reserve the right to cancel membership of any student should they deem it necessary. Neither Hyung Je Martial Arts nor any of its instructors accept any liability for injuries sustained during the course of participating in any Hyung Je Martial Arts events or taking part in any externally organised competitions or events or through the reckless behaviour of students.
I acknowledge and confirm that I have read and understood the Medical Questionnaire, Permission for marketing and publication of photos and the Disclaimer of Liability and I accept the terms contained therein.
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GDPR* This field is required.Hyung Je Martial Arts store and process the data that you have provided for the sole purpose of administrating the club membership and related activities. As part of our General Data Protection Regulation (GDPR) requirements, we are required to get your permission to contact you. We use emails to provide details of club events, such as tournaments, gradings, additional lessons and any class cancellations should they occur. You may withdraw consent at any time by asking any of the instructors. Full details of our GDPR policy can be found at www.hyungje.org
By completing this online form, I agree to be contacted by Hyung Je Martial Arts as described above.
18
To register for any special events such as gradings or tournaments we will send a link via email. Are you happy to contacted by email for this purpose?
Yes
No
19
When would you like to attend the free trial? Classes are held at Kennington Junior School on Tuesday's & Thursday's Juniors (age 6-12) @ 6:10pm Cadets (age 13-18) @ 7pm Adults (18+) @ 8pm
Date
Day
Month
Year
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